Towbin, Alexander J; Roth, Christopher J; Bronkalla, Mark; Cram, Dawn
With the advent of digital cameras, there has been an explosion in the number of medical specialties using images to diagnose or document disease and guide interventions. In many specialties, these images are not added to the patient's electronic medical record and are not distributed so that other providers caring for the patient can view them. As hospitals begin to develop enterprise imaging strategies, they have found that there are multiple challenges preventing the implementation of systems to manage image capture, image upload, and image management. This HIMSS-SIIM white paper will describe the key workflow challenges related to enterprise imaging and offer suggestions for potential solutions to these challenges.
Roth, Christopher J; Lannum, Louis M; Joseph, Carol L
Enterprise imaging governance is an emerging need in health enterprises today. This white paper highlights the decision-making body, framework, and process for optimal enterprise imaging governance inclusive of five areas of focus: program governance, technology governance, information governance, clinical governance, and financial governance. It outlines relevant parallels and differences when forming or optimizing imaging governance as compared with other established broad horizontal governance groups, such as for the electronic health record. It is intended for CMIOs and health informatics leaders looking to grow and govern a program to optimally capture, store, index, distribute, view, exchange, and analyze the images of their enterprise.
Roth, Christopher J; Lannum, Louis M; Persons, Kenneth R
Care providers today routinely obtain valuable clinical multimedia with mobile devices, scope cameras, ultrasound, and many other modalities at the point of care. Image capture and storage workflows may be heterogeneous across an enterprise, and as a result, they often are not well incorporated in the electronic health record. Enterprise Imaging refers to a set of strategies, initiatives, and workflows implemented across a healthcare enterprise to consistently and optimally capture, index, manage, store, distribute, view, exchange, and analyze all clinical imaging and multimedia content to enhance the electronic health record. This paper is intended to introduce Enterprise Imaging as an important initiative to clinical and informatics leadership, and outline its key elements of governance, strategy, infrastructure, common multimedia content, acquisition workflows, enterprise image viewers, and image exchange services.
Roth, Christopher J; Lannum, Louis M; Dennison, Donald K; Towbin, Alexander J
Clinical specialties have widely varied needs for diagnostic image interpretation, and clinical image and video image consumption. Enterprise viewers are being deployed as part of electronic health record implementations to present the broad spectrum of clinical imaging and multimedia content created in routine medical practice today. This white paper will describe the enterprise viewer use cases, drivers of recent growth, technical considerations, functionality differences between enterprise and specialty viewers, and likely future states. This white paper is aimed at CMIOs and CIOs interested in optimizing the image-enablement of their electronic health record or those who may be struggling with the many clinical image viewers their enterprises may employ today.
Ferguson, Matthew Robert
This is the exposition of a Western teacher working abroad in Thailand and his coming to terms with what it means to find a home and a sense of belonging while learning to teach in an unfamiliar land and culture. A foreign teacher finds himself isolated between feelings of perceived power (as an educated Westerner) and his all too real feelings of…
Witruk, Evelin, Ed.; Riha, David, Ed.; Teichert, Alexandra, Ed.; Haase, Norman, Ed.; Stueck, Marcus, Ed.
This book contains selected contributions from the international workshop Learning, "Adjustment and Stress Disorders--with special reference to Tsunami affected Regions" organised by Evelin Witruk and the team of Educational and Rehabilitative Psychology at the University of Leipzig in January 2006. The book contains new results and the…
Yenigun, Ayse; Ozkinay, Ferda; Cogulu, Ozgur; Coker, Canan; Cetiner, Nurten; Ozden, Gonca; Aksu, Oguz; Ozkinay, Cihangir
Immunological, endocrinological, and haematological abnormalities are relatively common in people with Down syndrome (Cuadrado & Barrena, 1996; Decoq & Vincker, 1995; Hestnes et al., 1991; Sustrova & Strbak, 1994; Nespoli, Burgio, Ugazio & Maccario, 1993; Kempski, Chessells & Reeves, 1997; Kivivuori, Rajantie, & Siimes, 1996; David et al., 1996;…
A new system has been developed for reporting safety issues in the workplace. The Environment, Health, and Safety’s (EHS’) Safety Inspection and Issue Management System (SIIMS) is an online resource where any employee can report a problem or issue, said Siobhan Tierney, program manager at EHS.
Morrison, James J; Hostetter, Jason M; Aggarwal, Abhi; Filice, Ross W
This paper describes the design and implementation of an application that parses and analyzes radiology report text to provide a radiologic differential diagnosis. The system was constructed using a combination of freely available web-based APIs and originally developed during the Society for Imaging Informatics in Medicine (SIIM) 2014 Hackathon. Continued development has refined and increased the accuracy of the algorithm. This project demonstrates the power and possibilities of combining existing technologies to solve unique problems as well as the stimulus of the hackathon setting to spur innovation.
Meenan, Chris; Erickson, Bradley; Knight, Nancy; Fossett, Jewel; Olsen, Elizabeth; Mohod, Prerna; Chen, Joseph; Langer, Steve G
For clinical departments seeking to successfully navigate the challenges of modern health reform, obtaining access to operational and clinical data to establish and sustain goals for improving quality is essential. More broadly, health delivery organizations are also seeking to understand performance across multiple facilities and often across multiple electronic medical record (EMR) systems. Interpreting operational data across multiple vendor systems can be challenging, as various manufacturers may describe different departmental workflow steps in different ways and sometimes even within a single vendor's installed customer base. In 2012, The Society for Imaging Informatics in Medicine (SIIM) recognized the need for better quality and performance data standards and formed SIIM's Workflow Initiative for Medicine (SWIM), an initiative designed to consistently describe workflow steps in radiology departments as well as defining operational quality metrics. The SWIM lexicon was published as a working model to describe operational workflow steps and quality measures. We measured the prevalence of the SWIM lexicon workflow steps in both academic and community radiology environments using real-world patient observations and correlated that information with automatically captured workflow steps from our clinical information systems. Our goal was to measure frequency of occurrence of workflow steps identified by the SWIM lexicon in a real-world clinical setting, as well as to correlate how accurately departmental information systems captured patient flow through our health facility.
Zhang, Hongsen; Zhang, Jian; Bao, Jie
This study reported a high titer gluconic acid fermentation using dry dilute acid pretreated corn stover (DDAP) hydrolysate without detoxification. The selected fermenting strain Aspergillus niger SIIM M276 was capable of inhibitor degradation thus no detoxification on pretreated corn stover was required. Parameters of gluconic acid fermentation in corn stover hydrolysate were optimized in flasks and in fermentors to achieve 76.67 g/L gluconic acid with overall yield of 94.91%. The sodium gluconate obtained from corn stover was used as additive for extending setting time of cement mortar and similar function was obtained with starch based sodium gluconate. This study provided the first high titer gluconic acid production from lignocellulosic feedstock with potential of industrial applications.
Langer, Steve G
In 1999-2003, SIIM (then SCAR) sponsored the creation of several special topic Primers, one of which was concerned with computer security. About the same time, a multi-society collaboration authored an ACR Guideline with a similar plot; the latter has recently been updated. The motivation for these efforts was the launch of Health Information Portability and Accountability Act (HIPAA). That legislation directed care providers to enable the portability of patient medical records across authorized medical centers, while simultaneously protecting patient confidentiality among unauthorized agents. These policy requirements resulted in the creation of numerous technical solutions which the above documents described. While the mathematical concepts and algorithms in those papers are as valid today as they were then, recent increases in the complexity of computer criminal applications (and defensive countermeasures) and the pervasiveness of Internet connected devices have raised the bar. This work examines how a medical center can adapt to these evolving threats.
Zhou, Ping-Ping; Meng, Jiao; Bao, Jie
The aim of this work is to study the citric acid fermentation by a robust strain Aspergillus niger SIIM M288 using corn stover feedstock after dry dilute sulfuric acid pretreatment and biodetoxification. Citric acid at 100.04g/L with the yield of 94.11% was obtained, which are comparable to the starch or sucrose based citric acid fermentation. No free wastewater was generated in the overall process from the pretreatment to citric acid fermentation. Abundant divalent metal ions as well as high titer of potassium, phosphate, and nitrogen were found in corn stover hydrolysate. Further addition of extra nutrients showed no impact on increasing citric acid formation except minimum nitrogen source was required. Various fermentation parameters were tested and only minimum regulation was required during the fermentation. This study provided a biorefining process for citric acid fermentation from lignocellulose feedstock with the maximum citric acid titer and yield.
Depeursinge, Adrien; Fischer, Benedikt; Müller, Henning; Deserno, Thomas M
Content-based image retrieval (CBIR) has been proposed as key technology for computer-aided diagnostics (CAD). This paper reviews the state of the art and future challenges in CBIR for CAD applied to clinical practice. We define applicability to clinical practice by having recently demonstrated the CBIR system on one of the CAD demonstration workshops held at international conferences, such as SPIE Medical Imaging, CARS, SIIM, RSNA, and IEEE ISBI. From 2009 to 2011, the programs of CADdemo@CARS and the CAD Demonstration Workshop at SPIE Medical Imaging were sought for the key word “retrieval” in the title. The systems identified were analyzed and compared according to the hierarchy of gaps for CBIR systems. In total, 70 software demonstrations were analyzed. 5 systems were identified meeting the criterions. The fields of application are (i) bone age assessment, (ii) bone fractures, (iii) interstitial lung diseases, and (iv) mammography. Bridging the particular gaps of semantics, feature extraction, feature structure, and evaluation have been addressed most frequently. In specific application domains, CBIR technology is available for clinical practice. While system development has mainly focused on bridging content and feature gaps, performance and usability have become increasingly important. The evaluation must be based on a larger set of reference data, and workflow integration must be achieved before CBIR-CAD is really established in clinical practice. PMID:21892374
Depeursinge, Adrien; Fischer, Benedikt; Müller, Henning; Deserno, Thomas M
Content-based image retrieval (CBIR) has been proposed as key technology for computer-aided diagnostics (CAD). This paper reviews the state of the art and future challenges in CBIR for CAD applied to clinical practice.We define applicability to clinical practice by having recently demonstrated the CBIR system on one of the CAD demonstration workshops held at international conferences, such as SPIE Medical Imaging, CARS, SIIM, RSNA, and IEEE ISBI. From 2009 to 2011, the programs of CADdemo@CARS and the CAD Demonstration Workshop at SPIE Medical Imaging were sought for the key word "retrieval" in the title. The systems identified were analyzed and compared according to the hierarchy of gaps for CBIR systems.In total, 70 software demonstrations were analyzed. 5 systems were identified meeting the criterions. The fields of application are (i) bone age assessment, (ii) bone fractures, (iii) interstitial lung diseases, and (iv) mammography. Bridging the particular gaps of semantics, feature extraction, feature structure, and evaluation have been addressed most frequently.In specific application domains, CBIR technology is available for clinical practice. While system development has mainly focused on bridging content and feature gaps, performance and usability have become increasingly important. The evaluation must be based on a larger set of reference data, and workflow integration must be achieved before CBIR-CAD is really established in clinical practice.
Nathan, I; Hackett, A F; Kirby, S
There is a lack of information concerning the diet of vegetarian children. The present study compared the dietary intake of fifty vegetarian children, aged 7-11 years, with fifty matched omnivores. Three 3 d food records were completed by each child at intervals of 6 months. The day after completing the record each child was interviewed to clarify food items and assess portion sizes. Food records were analysed using Microdiet (University of Salford). Finger-prick cholesterol and haemoglobin measurements were taken from a subsample of the group. Only one child's family was a member of the Vegetarian Society and almost one-third of vegetarian children had omnivorous parents (seventeen of fifty subjects). The energy intake (MJ) of the vegetarians was significantly lower than that of the omnivores, 7.6 (SD 1.05) and 8.0 (SD 1.36) respectively; there were no significant differences in Fe or fat intakes. For the vegetarians polyunsaturated:saturated fat ratio (P:S 0.7 (SD 0.04)) and NSP intake (13.8 (SD 0.7) g/d) were significantly higher than those of the omnivores (P:S 0.5 (SD 0.02), NSP 10.3 (SD 0.4) g/d). There was no significant difference in cholesterol measurements (mmol/l) between the two groups: vegetarian 3.5 (SD 0.12), omnivores 3.7 (SD 0.15). The haemoglobin level (g/l) of the vegetarians (11.8 (SD 0.2)) was significantly below that of the omnivores (12.4 (SD 0.2)); 47.5% of the vegetarian children fell below the third percentile of the Dallman reference curves (Dallman & Siimes, 1979). The intake of the vegetarians more closely resembled current recommendations (Department of Health, 1991), although they need to be as aware as omnivores of the need to reduce fat intake. The haemoglobin levels of vegetarian children suggest that they need dietary advice to ensure optimal absorption of Fe.
Thanks to a unique "ballistic study" that combines data from ESO's Very Large Telescope and NASA's Chandra X-ray Observatory, astronomers have now solved a long-standing mystery of the Milky Way's particle accelerators. They show in a paper published today on Science Express that cosmic rays from our galaxy are very efficiently accelerated in the remnants of exploded stars. ESO PR Photo 23a/09 The rim of RCW 86 ESO PR Photo 23b/09 DSS + insert, annotated ESO PR Photo 23c/09 DSS image ESO PR Video 23a/09 Zoom-in RCW 86 During the Apollo flights astronauts reported seeing odd flashes of light, visible even with their eyes closed. We have since learnt that the cause was cosmic rays -- extremely energetic particles from outside the Solar System arriving at the Earth, and constantly bombarding its atmosphere. Once they reach Earth, they still have sufficient energy to cause glitches in electronic components. Galactic cosmic rays come from sources inside our home galaxy, the Milky Way, and consist mostly of protons moving at close to the speed of light, the "ultimate speed limit" in the Universe. These protons have been accelerated to energies exceeding by far the energies that even CERN's Large Hadron Collider will be able to achieve. "It has long been thought that the super-accelerators that produce these cosmic rays in the Milky Way are the expanding envelopes created by exploded stars, but our observations reveal the smoking gun that proves it", says Eveline Helder from the Astronomical Institute Utrecht of Utrecht University in the Netherlands, the first author of the new study. "You could even say that we have now confirmed the calibre of the gun used to accelerate cosmic rays to their tremendous energies", adds collaborator Jacco Vink, also from the Astronomical Institute Utrecht. For the first time Helder, Vink and colleagues have come up with a measurement that solves the long-standing astronomical quandary of whether or not stellar explosions produce enough